Individual provider Active NPI

Andrew Ceelen

  • Nurse Practitioner
  • Grafton, WI
National Provider Identifier
1912498791
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
8081-033 Issued in WI
Practice address
975 Port Washington Rd
Grafton, WI 53024-9201
Phone
(262) 329-1000
NPI assigned
May 28, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 8081-033 WI Primary

Addresses

Primary practice location

975 Port Washington Rd
Grafton, WI 53024-9201

Mailing address

975 Port Washington Rd
Grafton, WI 53024-9201
Phone (262) 329-1000

Other practice location 1

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

Other identifiers 1

IdentifierTypeStateIssuer
1912498791MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address aceelen29507@direct.aurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180815003944 WI Practitioner - Nurse Practitioner 7618226184 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8081-033WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jun 27, 2018 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jun 27, 2018 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

975 Port Washington Rd
Grafton, WI 53024
Phone (262) 329-1000

975 Port Washington Rd
#320
Grafton, WI 53024
Phone (262) 329-8100

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Interoperability endpoints

  • Direct secure messaging: ms_aceelen@landmarkhealth-direct.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1912498791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 PORT WASHINGTON RD",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249201",
            "telephone_number": "262-329-1000",
            "fax_number": "262-329-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 PORT WASHINGTON RD",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249201",
            "telephone_number": "262-329-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W180N8000 Town Hall Rd",
            "address_purpose": "LOCATION",
            "city": "Menomonee Falls",
            "state": "WI",
            "postal_code": "53051",
            "country_code": "US",
            "telephone_number": "262-255-2500",
            "fax_number": "262-253-9501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEELEN",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-28",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "8081-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912498791",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aceelen29507@direct.aurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "975 Port Washington Rd",
            "city": "Grafton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530249201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "975 Port Washington Rd",
            "city": "Grafton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530249201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grafton, WI

Sources for this page

Verify at the official NPI Registry.